How Social Context Influences Brain Disorders

Source: Columbia University Press / Used with permission

Matthew Schelke has a gift for metaphors. His preferred one for describing how our brains take on the traits of our culture? “‘Clipping on’ to the social wire.”

Anyone who has hurtled down a zip line knows how thrilling the descent is. “You clip your carabiner onto a thin wire,” Schelke writes in Socially Wired: How Culture Shapes Our Brains, published this week, “then fly through the forest or down from a peak to an unfamiliar destination.”

Especially in old age, though, the clip doesn’t always form a snug fit—it can weaken, grow rusty, and stop working entirely. “When the clip is loosened, as happens in neurological illness,” Schelke notes, “it’s not always a matter of staying on or falling off but often about switching to a different trajectory.”

Challenging the Isolated Brain Model in Neurology

Based on patients seen at Columbia University’s Department of Neurology in New York City, where Schelke was chief resident in 2022-23, Socially Wired begins from the premise that neuroanatomy’s focus on “neural wiring” provides at best an “incomplete metaphor” of the brain in isolation.

Instead—and a challenge to isolationists wedded to the brain’s autonomy—“the link between the brain and mind is mediated through culture.” The dynamism that ensues revolutionizes understanding not just of the brain’s evolving relation to itself, but also of its many “shared affordances”—adopted habits and customs—that act on us psychologically and cerebrally as they pull us into something resembling convergence and adaptation.

“Brain health goes far beyond the skull”

Rendering some brain actions partly cultural, Schelke’s exciting shift in perspective raises a host of medico-philosophical questions for neurological care: “How do our social and cultural worlds transform our brains?” In particular, “What is the nature of the interaction between neural networks and cultural practices?”

Since “as neurologists know, no two patients with the same lesion are alike,” Schelke acknowledges, the case study presents immediate limitations as a genre. Its tendency to dwell on “unique or bizarre individual experiences” is inherently oversimplifying and often “lack[s] a broader framework.”

Another key theme of Socially Wired is that “manifestations of neurological illness vary widely depending on the social context.” Nevertheless, activities that stimulate the brain—for instance, cooking, singing, dancing, learning new languages and musical instruments, and taking exercise—encourage the neuroplasticity needed to offset cognitive decline, in some cases to delay and reverse its damage.

In the case of Gustavo, a sixty-three-year-old high school math teacher in New York City diagnosed with Parkinson’s and prescribed Sinemet (levodopa-carbidopa), he is strongly encouraged to resume his lifelong passion for salsa, and, when dancing is no longer physically possible, to transmute the same energy into administrative work for his club. In Schelke’s formulation, “The music exogenously activates the same basal ganglia networks that are necessary for isochronous gait, facilitating movement and improving ambulation.”

Other chapters tackle crucial contextual questions about strokes—for instance, why an art lover’s glioma in her medial prefrontal cortex leaves her unable to distinguish museum objects she must not touch (but does) from home-made pottery she very much can (and will). Encouraged to teach her granddaughter basic pottery, Laura joins Schelke’s other patients in creating “meaningful forms of intentional action within the framework of their illnesses.”

Practical Implications of Cultural-Mediated Brain Health

With the link between brain and mind firmly “mediated through culture,” an approach involving only the first will not help us “preserve or improve our mental abilities,” Schelke underscores. Put differently, “the sorts of interventions that are prominent today—medications, supplements, cognitive exercises, dietary changes, neural implants—may be helpful, but they are only half the equation.”

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Neuroplasticity And the Legacy of a Scientific Mistake

Corroborating the focus of Socially Wired on re-establishing neuroplasticity, the U.S. Centers for Disease Control and Prevention determined in August 2024 that “nearly 45% of all dementia cases may be prevented or delayed,” and swung its weight behind lifestyle and dietary changes known to aid in the prevention of neurodegenerative disease.

Schelke also aligns silently with the CDC in looking beyond pharmacotherapy, because the drugs prescribed for these conditions are not without controversy. A recent 2026 Cochrane Review on anti-amyloid drugs and their impact, which examined data from 17 clinical trials involving 20,342 participants with mild cognitive impairment, determined: “Drugs that target amyloid beta proteins in the brain likely have no clinically meaningful positive effects, while increasing the risk of bleeding and swelling in the brain. Researchers … found that the absolute effects of anti-amyloid drugs on cognitive decline and dementia severity were absent or trivial.”

Meanwhile, cholinesterase inhibitors like Donepezil, Memantine, and Aricept that are prescribed for chronic dementia are meant to halt the continued breakdown of acetylcholine, a neuro-messenger vital to memory, thinking, and reasoning, yet in some cases have been found to accelerate, not hinder, its destruction. Routine side effects include nausea and appetite suppression, muscle cramps, and difficulty sleeping.

The Role of Diet and Lifestyle in Supporting Brain Health

Above all, if boosting acetylcholine production in the brain is the goal, then a cholinesterase inhibitor may not be necessary. As the website “The Nutrition Source” confirms at Harvard’s T. H. Chan School of Public Health, “choline is an essential nutrient that is naturally present in certain foods”—walnuts, seeds, berries, legumes, dairy, fish, and poultry—which themselves assist in the removal of amyloid proteins that restrict blood flow in the brain, significantly reducing the risk of stroke and associated cognitive damage.

The neuroplasticity that Schelke wants lifestyle and dietary changes to rescue is not used to peddle false hope about dementia patients’ miraculous recovery from profound cognitive decline. It forms a constructive, evidence-based approach that interrupts the fatalism characterizing decline as inevitable and all else as medically naïve.

Just as the focus on brain health must center lifestyle, exercise, and dietary changes—including foods that boost acetylcholine production without risk of encephalitis and other dangerous adverse effects—so the brain’s complex wiring and capacity to rewire can break open the solipsism of a person and brain experiencing dementia, placing both of them once more in a vast social network where neuronal growth becomes the basis for reducing earlier damage.